NEW YORK (Reuters Health) – Spironolactone use is associated with improved long-term survival in patients with systolic heart failure, researchers from Japan report in the December American Heart Journal.

“Widespread application of spironolactone use in clinical practice may substantially improve the outcomes in the large numbers of patients hospitalized with heart failure,” Dr. Hiroyuki Tsutsui from Hokkaido University Graduate School of Medicine, Sapporo, Japan told Reuters Health in an email.

Dr. Tsutsui and colleagues analyzed the influence of spironolactone use on mortality and rehospitalization in 946 patients hospitalized with systolic heart failure who were registered in the Japanese JCARE-CARD study (435 (46%) were prescribed spironolactone). Average follow-up was 2.2 years.

The mean age of patients in the study was 66.3 years, and the mean left ventricular ejection fraction (LVEF) was 27.1%.

In multivariable models, discharge use of spironolactone reduced the risk of all-cause death by 38.1% and cardiac death by 47.6% compared with no spironolactone use.

Spironolactone use did not influence the risk of rehospitalization due to worsening heart failure or the combined end point of all-cause death or rehospitalization.

In subgroup analyses, spironolactone use was associated with a 39.5% reduction in the risk of all-cause death and a 50.8% reduction in the risk of cardiac death among patients with NYHA functional class I or II. In contrast, spironolactone use was not associated with outcomes among patients with an elevated serum creatinine (at least 2.5 mg/dL).

“Our registry data have provided further support for clinical trials [to learn whether] spironolactone could reduce the mortality risk in patients with heart failure and reduced ejection fraction,” Dr. Tsutsui concluded. “Spironolactone should be used more, especially in patients hospitalized with heart failure.”

Am Heart J 2010;160:1156-1162.